Eyes Flashcards
- signs and symptoms: itchy, burning, red swollen lid margin
- flakes/heavy crusting on the lashes
- lid redness and swelling
- foam along lid margin
- blocked meibomian glands
- can be associated with rosacea
***Most COMMON cause of bacterial conjunctivitis in adults
Mgmt: wash eyelids with baby shampoo, warm compresses and artificial tears.
Blepharitis/ Meibomian Gland Disease
What do you have to monitor with use of ocular topical steroids?
Intraocular pressure of eye
Also referred to as a “stye”
painful abscess of a hair follicle and sebaceous gland in the upper or lower eyelid
Hordeolum
A chronic inflammation of the meibomian gland (specialized sweat gland) of the eyelids
It may resolve spontaneously in 2-8 weeks
starts as a hordeolum but hardens over time
NOT PAINFUL
Mgmt: 10 minute warm compresses and lid massage
if chronic can give docycycline 100mg bid
Chalazion
Uncompleted lid closure associated with exophthalmos (hyperthyroidism)
Lagophthalmos
T/F Most cases of adult conjunctivitis are from viral and allergic causes
True
Can have crusting/mucous on eyelids and eyes in the morning but not typically all day long
tearing and burning
very contagious
usually starts in one eye and then spreads to the other eye
need to wash all pillow cases and bed linen and clothing that came in contact with eye
associated with recent upper respiratory infection
management: preservative free artificial eye drops and cold compresses
self resolving in 2-3 weeks
refer if pain on blink or change in vision
VIRAL CONJUNCTIVITIS
What are two causes of complicated bacterial conjunctivitis seen in the newborns?
Gonorrhea (ophthalmia neonatorum) and Chlamydia
Beefy red eyes
copious, mucous discharge from eyes ALL day
itching and irritation
management with topical antibiotics and child cannot return to school until 48 hours after starting antibiotics
Bacterial conjunctivitis
Blood that is trapped underneath the conjunctiva and sclera secondary to broken arterioles (burst blood vessel)
Can be caused by coughing, sneezing, heavy lifting, vomiting, local trauma or can occur spontaneously.
resolves within 1-3 weeks (reabsorbed) like a bruise
increased risk if on aspirin, anticoagulants and patient has hypertension
Subconjunctival hemorrhage
What is another name for Keratoconjunctivitis Sicca?
Dry eyes
What is the name of the test that determines the amount of tear production a patient has?
Schrimers test and it is used for diagnosis of dry eyes
T/F Patients with dry eyes should use visine or eye drops with vasoconstrictors in it as this will help the condition
False
Visine and vasoconstricting eye drops will worsen the condition and causes rebound effect= more dryness
Is the following condition consistent with pre-septal cellulitis or orbital cellulitis?
s/s: no pain on eye movement, eyes are not that red, no change in vision, optic nerve not swollen, and no or mild fever.
starts as a hordeolum or upper respiratory infection
managed with augmentin or Keflex for 10 days and warm compresses
Pre-Septal Cellulitis
Is the following episcleritis or scleritis?
Redness will blanch with 10% topical phenylephrine solution and episcleral vessels will be mobile on palpation?
Episcleritis
This eye condition can be seen in patients with rheumatoid arthritis, lupus, crohns disease, ulcerative collitis
Episcleritis
usually nodular, sectorial with mild pain or tenderness
Is Episcleritis usually unilateral or bilateral eye involvement?
Unilateral
if bilateral or recurrent do bloodwork
This condition usually resolves on its own but can give topical steroids for comfort
Describe scleritis
dull pain deeper in eye
with dark red or bluish hue to the sclera
needs ophthalmology referral
eye does NOT blanch with phenylephrine test and will remain red with test
can lead to perforation and vision loss
treated with NSAIDs (indomethacin) and topical agent
What do you treat Herpes Simplex of the eye with?
Oral OR topical anti viral agents
What do you treat Herpes Zoster with?
ONLY ORAL anti viral medications
**needs urgent referral to ophthalmologist because can cause blindness if not treated quickly
Is Herpes Simplex or Herpes Zoster associated with Hutchinson sign?
Herpes Zoster
Hutchinson sign= affects the ophthalmic branch of the trigeminal nerve and will have blisters on the tip of nose on the affected side of the face.
What condition is associated with overnight or extended wear contact lenses and causes severe ocular pain, injection more severe toward location of ulcer and requires corneal scraping and culture to determine causative agent?
Ulcerative Keratitis
What is the management of Ulcerative Keratitis
same day referral to ophthalmology
Do NOT patch eye
patient will have to instill eye drop antibiotics every 30 minutes-1 hour for 24 hours….even at night
What is the worse causative agent of ulcerative keratitis and can lead to vision loss?
acanthamoeba (fungal)
Gradual onset of increased intra ocular pressure of greater than 22 mmHg due to blockage of the drainage of aqueous humor inside the eye.
Most common type of glaucoma
Classic case:
most commonly seen in elderly patients, especially those of African American or Caucasian ancestry or diabetics. Usually asymptomatic during early stages. Gradual changes in PERIPHERAL vision (lost first) and then central vision. May complain of missing portions of words when reading. if fundoscopic exam shows cupping, IOP is too high Refer to ophthamologist
Open angle glaucoma
Normal range of IOP: 8-21 mmHg
IOP of 30 mmHg or more is considered very high; urgent referral within 24 hours or less to ophthalmologist or refer to the ED
Sudden blockage of aqueous humor which results in marked increase in intra ocular pressure which can result in blindness if not corrected quickly.
classic case
older patient complains of acute onset of decreased/blurred vision with severe eye pain and frontal headache that is accompanied by nausea and vomiting. with fixed and mid dilated cloudy pupil and pupil reacts very slowly to light. conjunctival injections with increased lacrimation (tearing).
Narrow Angle Glaucoma
use IOP lower agents 1% pilocarpine (or beta blockers, alpha agonists or oral Diamox).
Which eye disease can be associated with a systemic infection of
TB, sarcoidosis, crohns disease, ulcerative colitis, lupus, syphilis, bechet disease, Lyme disease, herpes and toxoplasmosis
Uveitis
ophthalmology will deal with eye care but as primary care you will need to evaluate the underlying cause of the eye condition.
T/F If patients vision improves with pinhole occluder than patient has a refractive error which will improve with glasses?
True
With sudden painless loss of vision: transient vision loss:
which condition improves with blinking?
migraine, dry eye syndrome, papilledema, amaurosis fugax or retinal detachment?
Dry eye syndrome
With sudden painless loss of vision loss: transient:
ALWAYS bilateral condition that lasts a few seconds and is due to increased intracranial pressure and no spontaneous venous pulsation seen on exam, bulging disc; URGENT referral
optic disc swollen with blurred edges due to increased intracranial pressure
migraine, dry eye syndrome, papilledema, amaurosis fugax or retinal detachment?
Papilledema
With sudden painless loss of vision: transient vision loss:
Parts of field of vision affected with positive aura (rainbows around lights ie) for 10-60 minutes with or without a headache
migraine, dry eye syndrome, papilledema, amaurosis fugax or retinal detachment?
Migraine with aura
With sudden painless loss of vision: transient vision loss:
hypoperfusion of globe, UNILATERAL and need to check for signs and symptoms of TIA, urgent referral to ED cause could be blood clot.
migraine, dry eye syndrome, papilledema, amaurosis fugax or retinal detachment?
Amaurosis Fugax
With sudden painless loss of vision: transient vision loss:
“curtain” in vision with gray or black preceeded by flashes and floaters
Sudden onset of a shower of “floaters” associated with “looking through a curtain” sensation with sudden flashes of light (photopsia)
migraine, dry eye syndrome, papilledema, amaurosis fugax or retinal detachment?
Retinal Detachment
T/F
If patient presents with retinal detachment but still has central vision this is urgent referral because the macula is still attached and can be saved?
True
What condition in patients over 50 years old can increase risk for giant cell arteritis?
Retinal Artery Occlusion (usually from embolus that looks like a cherry spot; have 24 hours to dislodge embolus).
What labs do we order to check for giant cell arteritis?
CRP and sed rate
What eye condition is referred to as “blood and thunder” and only has partial loss of field of vision
Retinal vein occlusion
- needs regular eye exam every 6 months to check for neovascularization
- also do blood pressure and cholesterol checks
A 50 year old man complains of marked scalp tenderness accompanied by a bad headache at his left temple and jaw claudication. He reports a sudden loss of vision in the left eye for the past several hours. the neurological exam is normal except for the loss of vision in the left eye.
Which of the following conditions is most likely:
A. cluster headache
B. migraine with aura
C. migraine without aura
D. giant cell arteritis
D. Giant cell arteritis
Which of the following diagnostic tests would be most helpful in the diagnosis of giant cell arteritis? A. CT scan of the brain B. Cranial nerve exam C. sedimentation rate D. CBC with differential
C. Sedimentation rate
What test is done for definitive diagnosis of giant cell arteritis?
Temporal artery biopsy
What are some other causes of sudden, painless loss of vision which is not urgent and can wait for eye exam for one week?
cataracts, open angle glaucoma, refractive error, diabetic retinopathy
Pain on eye movement which can be first sign of MS (between ages of 18-45), which has loss of vision over days, with decreased color perception, nerve can look swollen when looking at fundus and need neuro-ophthalmology consult and MRI with gadolinium
Optic Neuritis
What should you see with unilateral severe sudden vision loss?
RAPD
Relative Afferent Pupillary Defect
Migraine related flashes with aura
- lasts minutes to hours
- usually bilateral
- usually more than one “flickers”
- can start in the center of vision
- with or without headache
What conditions can intermittent double vision be seen with?
myasthenia gravis with fatigue (diplopia worse at end of day, with ptosis but no pupil involvement). ptosis improves with ice
MS
thyroid eye disease (hyperthyroidism involving inferior rectus muscle usually)
T/F Monocular diplopia is rarely an urgent condition
True
RAPD (relative afferent pupillary defect)
hold light in front of each eye for 2-3 seconds and look for lag in dilation of pupil
Which is worse with a chemical burn to the eyes…alkaline or acid burn
Alkaline
it may cause perforation
How long and with what solution do you irrigate the eye with after a chemical burn?
30 minutes with sterile/saline water to stabilize the pH
With high velocity foreign body injury to eye what two tests do you need to rule out intraocular and intraorbital foreign body
CT scan and dilated eye exam
What test can detect globe injury
Seidel test
look for leaking fluorescein stain
do not remove foreign body if test positive just stabilize it
